Monday, November 28, 2016

Methylphenidate-CBT Combination May Improve Cognitive Functioning in Patients Following TBI

Treating patients experiencing cognitive impairments following a traumatic brain injury (TBI) with a combination of methylphenidate and a type of cognitive-behavioral therapy (CBT) known as Memory and Attention Adaptation Training (MAAT) may lead to greater improvements in attention, working memory, and episodic memory than either treatment alone, reports a study published last week in Neuropsychopharmacology.

The findings of the small clinical trial point to the potential value of combining cognitive rehabilitation and pharmacotherapy to tackle one of the most persisting and debilitating TBI-related issues.

Brenna McDonald, Psy.D., M.B.A., of Indiana University School of Medicine and colleagues randomly assigned 76 adults aged 18 to 65 who reported cognitive deficits resulting from a traumatic brain injury to one of two cognitive rehabilitation interventions: MAAT, which aims to enhance skills for self-managing and coping with cognitive failures in daily life, and Attention Builders Training (ABT), a repetitive practice intervention with no active cognitive-behavioral component. Patients in each rehabilitation group were randomly assigned to receive either placebo or methylphenidate (MPH) twice daily. All the patients in the study had experienced a TBI at least four months prior to the study enrollment.

After six weeks, patients in the MAAT/MPH group showed significantly higher performance than the ABT/MPH group on the Paced Auditory Serial Addition Test Trial 3, which measures divided attention and working memory; the MAAT/MPH group also scored higher on the episodic memory-testing Brown Location Test than both the ABT/MPH and MAAT/placebo groups.

“We demonstrated that combined treatment with a manualized cognitive rehabilitation approach and MPH resulted in modest but statistically significant improvements in cognitive functioning on measures of verbal and nonverbal learning, working memory, and divided attention in adults with persistent cognitive symptoms after TBI,” the authors wrote. “While additional research is needed to replicate these promising initial findings, the current results provide support for multimodality treatment approaches to improve cognitive functioning even months to years after TBI.”

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